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Vol.58 No.2 contents | Japanese/English |
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- Case Report -
A Resected Case of Metachronous Multiple Adenocarcinomas That Developed in the Same Lobe After Chemoradiotherapy for Small Cell Lung Cancer
Atsushi Ito1, Motoshi Takao1, Akira Shimamoto1, Hideto Shimpo1, Katsunori Uchida21Department of General Thoracic and Cardiovascular Surgery, 2Department of Clinical Pathology, Mie University School of Medicine, Japan
Background. It is difficult to differentiate whether new pulmonary nodules in long-term survivors of small cell lung cancer represent lung metastasis or a second metachronous malignancy. Case. A 67-year-old woman was diagnosed with limited stage small cell lung cancer (LS-SCLC, cTxN2M0) by mediastinal lymph node biopsy. She was treated with concurrent chemoradiotherapy consisting of six cycles of carboplatin and etoposide and radiotherapy (54 Gy) of the hilar and mediastinum regions. She achieved a clinical complete response and underwent prophylactic cranial irradiation. At the four-year follow-up examination, chest computed tomography (CT) revealed three nodules in the right upper lobe (S1a, 11 mm; S1b, 5 mm; S2b, 6 mm). CT guided biopsy of the nodule in S1a resulted in a diagnosis of adenocarcinoma with no features of recurrent SCLC. We performed right upper lobectomy and lymph node dissection by complete video assisted thoracic surgery. A histopathological examination of the resected specimen revealed that all of the nodules were adenocarcinomas of different subtypes. A gene mutation analysis revealed that all were EGFR wild type, but the same K-ras mutation of codon 12 was found in both the S1a and S2b tumors. Thus, the diagnosis was multiple pulmonary adenocarcinoma with intrapulmonary metastasis, pT3N0M0 (Stage IIB). The patient is currently well without recurrence at 20 months after surgery. Conclusion. We herein described a case of metachronous multiple pulmonary adenocarcinomas in the same lobe that occurred four years after chemoradiotherapy for LS-SCLC.
key words: Small cell lung cancer, Chemoradiotherapy, Metachronous multiple lung cancers, Intrapulmonary metastasis
Received: November 2, 2017
Accepted: January 9, 2018
JJLC 58 (2): 93-98, 2018
